Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
Ann Surg. 2019 Sep;270(3):564-572. doi: 10.1097/SLA.0000000000003425.
This study assesses the impact of a telemedicine-based home management program (THMP) on patient adherence, hospital readmissions, and quality of life (QOL) after liver transplantation (LT).
Telemedicine interventions represent an opportunity to personalize care and can lead to improved adherence and patient satisfaction. However, there is limited data on impact of these interventions on outcomes after LT. Therefore, we conducted the first randomized controlled trial (RCT) of a THMP compared to standard of care (SOC) after LT.
One hundred six consecutive LT recipients were randomized (1:1) to 1 of 2 posttransplant care strategies: SOC or THMP. The THMP included an electronic tablet and bluetooth devices to support daily text messages, education videos, and video FaceTime capability; data was cyber-delivered into our electronic medical record daily. Endpoints were THMP participation, 90-day hospital readmission rate, and QOL.
One hundred patients completed the study with 50 enrolled in each arm. Participation and adherence with telemedicine was 86% for basic health sessions (vital sign recording), but only 45% for using messaging or FaceTime. The THMP group had a lower 90-day readmission rate compared to SOC (28% vs 58%; P = 0.004). The THMP cohort also showed improved QOL in regards to physical function (P = 0.02) and general health (P = 0.05) at 90 days.
To our knowledge, this is the first RCT demonstrating the impact of THMP after LT. The magnitude of effect on LT outcomes, hospital readmissions, and QOL suggests that the adoption of telemedicine has great potential for other major operations.
本研究评估了基于远程医疗的家庭管理方案（THMP）对肝移植（LT）后患者依从性、再入院率和生活质量（QOL）的影响。
远程医疗干预代表了个性化护理的机会，可提高依从性和患者满意度。然而，关于这些干预措施对 LT 后结果的影响的数据有限。因此，我们进行了首次比较 LT 后 THMP 与标准护理（SOC）的随机对照试验（RCT）。
106 例连续 LT 受者随机（1:1）分为 2 组：SOC 或 THMP。THMP 包括电子平板电脑和蓝牙设备，以支持每日短信、教育视频和视频 FaceTime 功能；数据每日通过网络传输到我们的电子病历中。终点是 THMP 参与度、90 天内再入院率和 QOL。
100 例患者完成了研究，每组 50 例。基本健康检查（生命体征记录）的远程医疗参与度和依从性为 86%，但使用消息传递或 FaceTime 的比例仅为 45%。THMP 组的 90 天内再入院率低于 SOC 组（28%比 58%；P=0.004）。THMP 组在 90 天时在身体功能（P=0.02）和一般健康（P=0.05）方面的 QOL 也有所改善。
据我们所知，这是首次证明 LT 后 THMP 影响的 RCT。THMP 对 LT 结果、再入院率和 QOL 的影响程度表明，远程医疗的采用对其他主要手术具有巨大潜力。
